Just to be sure, when was the blood draw for those labs in relation to your med changes?
Also what were your symptoms and lab test results when originally diagnosed?
When you were on the 137 mcg of Levo did you have symptoms other than "brain fog"?
Your PCP obviously doesn't understand about hypothyroidism. Switching you from 137 mcg of T4 to 75 mcg of T3 effectively almost doubled your med. On top of that, T3 reaches peak effect on serum levels in about 3-4 hours, so the usual approach is to split the dose and take half in the morning and half in the afternoon in order to smooth out the effect over a longer period. Because of that it is also a good idea to defer morning dose until after blood draw for any thyroid testing, in order to avoid false high results.
And yes, T4 levels matter. T4 is converted to T3 to be metabolized in cells throughout the body. Reserves of T4 circulating throughout the body is available for conversion as needed throughout the full day. I am also sending you a PM with a link to info on the effects of taking T3 med only.
Okay, so you are headed back in the right direction. What you should be looking for is to raise your med doses as needed to get to are Free T4 at mid-range at least, and Free T3 in the upper part of its range, or as needed to relieve hypo symptoms. So you should make sure they always test for both Free T4 and Free T3, not Total T4 and T3, like shown above. The Totals represent all that is in your blood. Most of that is tied to protein and biologically active. Only the small portions that are free of protein are active. Also, don't forget to defer your morning dose of med until after blood draw, to avoid false high results.
In addition it would be a good idea to test for Reverse T3, just to know that level. Reverse T3 is a mirror image of T3, but biologically inactive. Reverse T3 is a normal result of conversion of T4 to T3, but under some adverse conditions excess Reverse T3 is produced and it interferes with Free T3. Also, since hypo patients are so frequently low in the ranges for Vitamin D, B12 and ferritin, it would be good to test those and supplement as needed to optimize. I don't know about your ability to get the doctor to test for you, but if at all possible I would also ask for a morning serum cortisol test.
If you want more info on this and also something you can use for discussion with your doctor have a look at this link.
There is an old saying, "If it walks like a duck and quacks like a duck it most likely is a duck." With your symptoms and lab results and history of meds and dosages, my bet would be that it is primarily a thyroid problem.
In addition since hypo patients are so frequently deficient in Vitamin D, B12 and ferritin, I highly recommend testing for those and supplementing as needed to optimize. D should be 50 min., B12 in the upper end of its range, and ferritin should be a minimum of 70. And don't overlook testing for Reverse T3 along with your next Free T3 and Free T4 tests. Also, I suggest the morning serum cortisol test.
Did the doctor give you an alternative of staying at a higher dose of T3 and gradually reducing the dosage until the T4 med has time to kick in?
I think the doctor needs to do something to give you some short term relief while you are rebuilding your Free T4 level. I would try to make contact with his emergency number and relate how badly you are feeling and request to increase your T4 med significantly for a week to try and raise your level faster. Also anything else the doctor can suggest to help in the short term.
Since hypo patients are so frequently too low in the ranges for Vitamin D, B12 and ferritin, I would also get those tested ASAP. D should be bout 50 min. , B12 in the upper end of its range, and ferritin should be 70 minimum. Low levels of those can cause symptoms, especially fatigue.
And by all means if you get to feeling too bad, don't hesitate to go to the ER.
Yes, that is what I am suggesting that you try and get your doctor to do for you: a short term significant increase in T4 med to try and get your Free T4 normalized as soon as possible.
Thank you for your response, I made a mistake I am taking liothyronine 10mcg at night and morning along with 112mcg levotheroxine in the morning.
I thought about switching the dose to
Night time to see if that changes anything.
After being on liothyronine for around six months straight at 75 MCG's once a day. I'm now on the 10th day of my new dosages.I know I need to stay patient but I'm trying to figure out when I will start seeing improvements in the t4 kicking in. I have a baby girl coming in a month and I'm trying to do the best at work and I just feel really pressured. It's hard for me to stay awake at all to even get off the couch. It feels like somebody reached inside my head Out lol. I'm not processing things nearly as fast as I usually do.
Are year ago I was on 137 MCG's of levethyroxine and felt ok and only had small symptoms. My just a small increase of my t4 would have done the trick.
Jchild83 I agree with telus2 that taking that much T4 for more than a week would be too much.
telus2 I am not clear about your numbers on daily production of T4 and T3 by a normal thyroid gland. I find in the following that it states that, "The overall production rate of T3 per day is approximately half that of T4 (50 vs 110 nmol), and circulating levels of free T3 (FT3) are approximately 3- to 4-fold less than that for free T4 (FT4) (5 vs 20 pmol/liter)." Also, it states that, In view of the very long circulating half-life of T4, it is probably not surprising that no circadian rhythm has been described. Absolute circulating levels are determined by secretion as well as clearance, and because T3 has a shorter half-life, one might predict that if TSH stimulates a proportion of T3
release from the thyroid, then a circadian rhythm would be evident."
Also, in another reference it was stated that the production of T4 was about 80% of total, while T3 was about 20%. Since circulating levels are determined from endogenous and/or exogenous sources as well as clearance rate, I'm not even sure how to best utilize this info. I guess one could interpret the circadian rhythm of TSH and Free T3 in normal circumstances as indicating that there is a increase of Free T3 starting at about 10 o:clock or so as preparation for awakening. Taking this into account would suggest that medicating at night might be best; however some people have sleep problems with that approach. Cortisol exhibits a similar pattern to help get us out of bed. So I think that the bottom line is that the best time to take thyroid med is whatever works best for the individual. Since I do struggle with awakening early, I think I will try taking a small portion of my T3 med at night just to see if it makes a difference for me.
With all the variables, it seems that the key thing is to get Free T4 and Free T3 levels high enough to relieve hypo symptoms, without creating any hyper symptoms. Those levels have been shown to be different among different people. Serum thyroid levels may not accurately reflect tissue thyroid levels due to thyroid hormone transport into the cells being affected by many variables. And of course thyroid hormone at the cellular level is even affected by levels of Vitamin D, cortisol and even TSH. So the resulting tissue thyroid effects (symptoms) may vary widely for the same serum thyroid levels of Free T4 and Free T3. So the paramount objective must always be the relief of symptoms, not specific dosages or serum levels.
When you were varying your med dosage, how did you determine if levels were too low or too high?
It has always seemed to me that the very best possible med for hypo patients would be timed release type containing both T4/T3 in natural proportions. Unfortunately that doesn't exist at present and I have heard of no efforts to develop such a med. I had not even heard previously of anyone having a timed release T3 med that worked adequately. So, I am glad to hear of your success with timed release T3 from at least your source anyway.
You Guys of been really helpful, my doctors in the past just went by tsh levels which I know now doesn't tell the whole story. I've never felt nearly as bad as I do now. From what I've read 75mcg of t3= 300mcg of t4 which is more than double what I was taking. I'm just hoping my endo has me on the right path now with getting my back on t4. I can't live like this, I can't think and inconatantly feel dizzy.
Just for info, there are a couple of scientific studies that say the correct factor is 3 to 1, not 4 to 1.